Healthcare Provider Details

I. General information

NPI: 1336252063
Provider Name (Legal Business Name): LUIS ALFONSO PADILLA-PAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2117
US

IV. Provider business mailing address

4610 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2117
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-4495
  • Fax: 505-842-8025
Mailing address:
  • Phone: 505-559-4495
  • Fax: 505-842-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number2002-0087
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: